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General NPI Number Information
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NPI Number | 1699826263
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Entity Type | Organization
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Legal Business Name | TOTAL WELLNESS INC
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 160 HOWELLS RD
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City | BAY SHORE
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State | NY
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Zip | 11706-5320
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Country | US
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Telephone | 631-666-4297
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Fax |
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Provider Business Mailing Address
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Address Line | 160 HOWELLS RD
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City | BAY SHORE
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State | NY
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Zip | 11706-5320
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Country | US
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Telephone | 631-666-4297
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. MARLISA BROWN
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Credential | MS RD CDE CDN
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Telephone | 631-666-4297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 000691-1
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License Number State | NY
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